Those of us engaged in medical and nutritional research all too often fail to understand the difference between the three entirely different processes involved in initiating a program of health promotion, that is medical/nutritional research, policy-making, and, finally, the practical implementation of policy by health promotion in its widest sense. Only too clear, however, is the need to produce coherent, simple documents that illustrate and explain the link between diet and disease. And non specialists need such tools if they are to understand and use the information efficiently. Such an undertaking would, of course, from a research scientist’s point of...

Diet may influence coronary heart disease (CHD) in several ways. It can affect lipoprotein levels in blood plasma, as well as the behaviour of cellular elements such as platelets, substances that participate in the development of atherosclerotic plaques and in the ultimate thrombosis that usually causes heart attacks. From many studies in animals fed cholesterol or fat-rich diets, however, it appears that deposition of cholesterol in developing plaques is essential to formation of the complicated lesions that almost invariably underlie the thrombotic event. I shall limit my remarks to the influence of dietary and hereditary factors on plasma lipoprotein levels...

Diet greatly affects many of the risk factors which cause coronary heart disease. In fact, nutrition itself must be listed as one of the major risk factors because of its tremendous modifying effects on the disease process, atherosclerosis. The most important risk factor in which diet plays the major role, both in causation and in treatment, is hyperlipidemia (See Fig. i).

Hyperlipidemia is important because it forms the basis for the excessive infiltration of lipid into the arterial intima with atherosclerosis an ultimate consequence. Stage 1 in the development of coronary heart disease is hyperlipidemia or, as depicted in the...

Dr Richard Havel has described the influence of plasma lipoproteins and nutrients on atherogenesis and coronary heart disease earlier in this conference (1) and Dr William Connor has explained how the diet can be altered to decrease the risk of coronary disease (2). Over the last three decades there have been a number of clinical trials using diet and/or lipid lowering medications aimed at reducing the high incidence of coronary heart disease. This paper will review the results from some of these intervention trials.

Atherosclerosis is a kind of “hardening of the arteries” causing thickening of the wall and narrowing...

Cardiovascular diseases (CVD) form the major public health problem in Finland. The province of North Karelia has proved to have the highest occurrence of CVD within Finland. From 1969 to 1971 CVD accounted for 43% of total mortality among North Karelian men aged 35-64 years. Awareness of this severe problem in North Karelia led to the development of a community-based prevention program for CVD, the North Karelia Project (1). The North Karelia Project was the first systematic attempt to implement the community approach to reduce the high CVD rates in the entire population of that area. The project was originally...

Diet is probably involved in the causation of most hypertension and should be involved in the treatment of virtually all hypertension. For simplicity, I shall consider the major dietary components separately, providing a bit about their role in causation, which remains uncertain, and more about their role in treatment, which is fairly well established.

About half of hypertensives are overweight, and the prevalence of hyptertension rises progressively at all ages with increasing degrees of obesity. The tendency for the blood pressure to rise with weight gain probably reflects the interaction of multiple factors, including hormones, fluid volume, and cardiac function....

The name diabetes mellitus originates from two Greek words:diabetes,passing through, andmeli,honey; so called because, when the disorder is poorly controlled, the urine contains much suger and is like honey. Diabetes is a metabolic disorder characterized by a deficiency or lack of effectiveness of insulin, a hormone produced by the betacells in the pancreas. An important function of insulin is to stimulate the uptake of glucose from the blood into the tissues. A lack of insulin therefore leads to the presence of raised blood glucose levels and the presence of glucose in the urine, the two hallmarks...

By no means is there a simple relationship between nutrient energy intake and body fat content. Indeed, wide interindividual variations exist as to the quantity of nutrient energy that contributes to the development of obesity (1-6). Variability persists even after relating intake to estimates of energy expenditure in the form of physical activity. While studies of monozygotic twins, including those reared by adoptive parents, indicate strong genetic factors for the development of adiposity (including the thermic response to food, even after physical training) (7-9), some dissimilarity might still occur because of unequal distribution of cytoskeletal elements during cleavage of the...

The goals of therapy of chronic renal failure before the patient must be treated by dialysis or transplantation are: first, to minimize mineral and electrolyte disturbances; second, to lower or reduce the pool of accumulated waste products; third, to maintain adequate protein nutrition; and, fourth, to retard or, in some cases, halt the progression of renal insufficiency. The three latter goals will be discussed in this article.

Principles of nutritional biochemistry led us to use low-protein diets, and our results indicate that this type of therapy can be used safely and can have a major impact on the course of...

“You are what you eat” is a popular saying. Perhaps it has greater relevance than many modern health professionals are prepared to accept. As early as 1799, Easton wrote a volume,Longevity,in which he presented biographical data on individuals who lived to the age of 100 years or more (1). What these centenarians appeared to have in common was that they tended to eat rather sparingly and were physically active.

Modern man in the developed countries of the post-industrial age is probably more sedentary in his lifestyle than any of his forebears. In addition to his levels of activity,...

It is by now widely recognized that the average age of Americans is increasing. The percentage of Americans over age 65, 75, or 85 has been increasing dramatically in this century, and these percentages are projected to continue to increase over the next four decades. This increase in the aging population has stimulated attention to the special health problems of elderly adults. One confusing aspect of discussions dealing with the elderly is our lack of a satisfactory definition of aging. What is old? Who is old? When does one become old? Clearly, physiological age is not the same as chronological...

It is frequently stated that alcoholism is one of the principal causes of nutritional disturbance in the adult population of North America and the rest of the developed world. This assertion appears to be consistent with the commonly held concept of the alcoholic as a “skidrow” drinker, grossly undernourished, and suffering from a variety of nutritional disorders such as beri-beri, peripheral neuropathy, macrocytic anemia, and Wernicke-Korsakoff syndrome. This picture of the alcoholic is often “explained” by two assumed “facts”: 1. that the alcoholic spends all day drinking and not eating and is therefore grossly undernourished, and 2. that ethanol provides...

To understand the possible effects of nutritional status on the skeleton, it is necessary to review briefly the central features of bone physiology. Bone tissue is formed by a specialized group of cells known as osteoblasts, which synthesize and secrete an unmineralized matrix, osteoid. Shortly after its formation, osteoid is “mineralized” by the precipitation of calcium-phosphate salts (hydroxy-appatite) within the matrix. Initial or primary mineralization occurs rapidly over a few days, but the final calcified density is not achieved for several months (1). After cessation of longitudinal growth, the whole skeleton goes through a phase of “consolidation”, during which gradually...

Nutrition and diet are closely related to cancer development in human beings (1,2). For instance, intake of high levels of calories and fat is related to high incidence of cancers in the colon and breast in humans. In addition, a high intake of protein is also claimed to be related to high incidences of cancers in certain organs like the urinary bladder. Minor elements such as vitamins and selenium are also related to human carcinogenesis, and a high daily intake of salt is generally thought to enhance stomach carcinogenesis. Nitrite and nitrate intakes are closely related to in vivo production...

In 1964 one of us (JVJ) was looking at the correlation between cardiovascular disease mortality and cancer mortality using the 1958 death rates from 19 countries. Although primarily interested in the relationship between coronary mortality and lung cancer mortality, a much stronger correlation emerged by chance, i.e. that between stroke mortality and stomach cancer mortality. Only much later it appeared that the relationship had already been observed in Japan in the late ’50s using mortality data of the towns, cities, and villages in the Miyagi prefecture by Hiraide, Fujisaku, and co-workers. Their paper was only published in Japanese and the...

I shall discuss the epidemiology of these two cancers from the viewpoint of the possible association between them and dietary fat consumption.

There are remarkable similarities in the epidemiology of these two cancers; both show substantial international variation, with high rates in North America and Western Europe and low rates in Japan and other parts of Asia (1). In individual cancer registries the correlation between incidence of colon cancer and breast cancer in women is high, 0.84, almost as high as the correlation between breast and rectal cancers, 0.72. In fact, the correlation is higher than that between colon and...

In 1981 Doll and Peto (1) published a review and assessment of causes of cancer in the United States which further stimulated the already vigorous research on diet and cancer. In discussing the earlier studies of caloric restriction, they suggested that the direction of research might have been changed drastically had the control mice been regarded as fat instead of the calorically-restricted mice being seen as undersized. Their estimation was right on target!

The earliest study of caloric restriction (in the form of underfeeding) was reported by Moreschi (2) in 1909, who found that transplanted sarcomas grew less vigorously in...

There are two points to be considered in this presentation. These are the development and use of dietary guidelines, including goals and recommendations; and the question of guidelines for whole populations as opposed to groups or individuals at high risk.*

The development of dietary guidelines on which to base a rational public policy is dependent first of all on the collection and analysis of data. Opinions are of little value, and it is important to have a sound base of factual information. Where there is wide disparity in the data that are being reported, the methodology needs to be examined...

It is not that long ago that dietary guidelines were considered to be of almost exclusive interest to departments of health and to health professionals. During more recent years their significance to a wider range of interest groups has been recognized. Among these one must include the various chronic disease associations, consumer groups, and of course the agri-food industry.

In most developed countries, the interest and concern of the average consumer in a variety of nutrition issues is growing. These nutrition concerns have had, and continue to have, an impact on food consumption trends, with these trends having a direct...

I have spent some time in both camps but I have spent more time being an academician than I have being on the industry side, so I can take some liberty and say a lot of things that some of my industrial colleagues might not be able to say!

Let me start out by making a few observations that I think are relevant. I am going to try to keep my comments very brief. First, it is important to realize that the food industry is not a single industry. Everyone talks about the food industry’s role related to the implementation...

Dietary guidelines are the focal point for policies and programs undertaken by the majority of dietitians and public health nutritionists around the world. Consequently, you are actively involved in implementing the dietary guidelines whether they are simple statements of carbohydrate and fat requirements, the more complex guidelines for general health, those for specific disease states, or for specific age groups such as the Nutrition in Pregnancy: National Guidelines recently released in Canada.

The steps that are taken emanate from activities in the work environment, in professional associations, and in individual actions. Dr. Beare–Rogers will be describing the process that...

As the third to last speaker on the last day of a two-and-a-half-day conference, I feel blessed, as I am sure you do, by the fact that I have been asked to speak for only ten minutes. I don’t want to listen to anyone - including myself - for even that long this morning. Nevertheless, I am here, representing nutrition educators, and I am supposed to tell you what we educators might do to help implement the dietary guidelines.

Ideally, we might do a lot. In the interest of time, I would like to ignore the question of whether nutrition...

The topic of this symposium relates to preventive medicine in the broadest sense - as it applies not only to physicians, but to other health professionals and public health authorities. Implementing some of the solutions proposed poses several major problems. Those problems can be quite variable, depending on whether they apply to the individual patient sitting in the doctor’s office or to community public health policies.

Let me confess a personal bias at the outset. I was brought up in the school of nutritional philosophy typified by the American writer Jack Douglas, who uttered the immortal statement: “If I had...

Nutrition Recommendations came to Canada in 1977. They arose, somewhat mellowed, from the Report of the Committee on Diet and Cardiovascular Disease, popularly known as the Mustard Report, and became the foundation for educational programs and regulatory actions relating to nutrition.

These early recommendations gained the support of other federal government departments concerned with food, and with provincial governments, professional organizations, as well as food producers and consumers. Dr T.K. Murray, then Director of the Bureau of Nutritional Sciences, spearheaded their development and acceptance. They were generally seen as moderate and sensible guidelines based upon the strongest scientific evidence available...

One of the major human accomplishments in the last 200 years has been the prevention of premature death. Readers of this article should realize that, if they had been born at any time before the middle of the eighteenth century, a quarter of them would have died before even learning how to read.

As we shall see, throughout the history of Homo sapiens, until about 1750, the balance of life and death hardly changed at all. Populations survived because each woman of reproductive age produced on average five or six children; of the two or three that were female, one...